Orthopedic Coding Alert

Spinal surgeries often require add-ons, which can bring you up to $450+ CPT is full of "add-on" codes, from minor and major surgical procedures to E/M services, but special rules apply to these codes. If you can keep just four points in mind, you can gain the best possible reimbursement for your add-on procedures every time. Point 1: Identify Add-On Codes by the '+' To identify add-on codes in CPT, look for a "+" symbol to the left of the code. In addition, all add-on codes contain a variation of the phrase "List separately in addition to code for primary procedure" in their CPT descriptors. A typical add-on code listing appears
as follows:

  +22614 - Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment (list separately in addition to code for primary procedure). "The 'plus' designation identifies those codes that the physician performs in addition to other, usually closely related, procedures or services," says Tara L. Conklin, CPC, an instructor for CRN-Institute, a coding and reimbursement institution offering courses in reimbursement, medical billing, outpatient coding certification and inpatient coding certification. "That's why they are called 'add-on' codes: You cannot report them alone, but always 'add them on' to another procedure or service."
 
Example: A surgeon would never use an operating microscope (69990) in the absence of a surgical procedure that required her to visualize a particular anatomic location. Because you would only bill 69990 in addition to another procedure, CPT lists the code as an add-on.
 
Some E/M services qualify as add-on codes as well. For instance, you may report prolonged services (such as +99354, Prolonged physician service in the office or other outpatient setting requiring direct [fact-to-face] patient contact beyond the usual service [e.g., prolonged care and treatment of an acute asthmatic patient in an outpatient setting]; first hour [list separately in addition to code for office or other outpatient evaluation and management service]; and +99355, ... each additional 30 minutes) only in addition to other, primary E/M services, such as an outpatient visit, consult, etc.
 
Note: For a complete list of add-on codes, consult Appendix D of CPT. Point 2: List Add-Ons With a Primary Procedure As noted above, you should never report an add-on code without also listing a "primary" procedure. Rather, the add-on code describes additional intraservice work associated with specific primary procedures the physician performs during the same operative session or patient encounter, says Anita L. Carter, LPN, CPC, an instructor at A+ Medical Management and Education, a school for billing and coding in Absecon, N.J.
 
In most cases, the primary code(s) for a given add-on code immediately precede the add-on code in the CPT listings. For example, consider the following CPT
code sequence:

  22520 - [...]